Infertility is a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman, unblocked fallopian tubes that allow the sperm to reach the egg, the sperm’s ability to fertilize the egg when they meet, the ability of the fertilized egg (embryo) to become implanted in the woman’s uterus, and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

What Causes Infertility?

In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to female factors. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.

The most common male infertility factors include azospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, a genetic disease such as cystic fibrosis or a chromosomal abnormality causes infertility in men.

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids can be associated with repeated miscarriages.

How is Infertility Diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will ask many questions and conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of ovulation, x-ray of the fallopian tubes and uterus, and perhaps a laparoscopy. For men, the initial test is a semen analysis.

How is Infertility Treated?

Eighty five to 90 percent of infertility cases are addressed through conventional therapies, such as drug treatment or surgical repair of reproductive organs. A recent government survey reported that only five percent of infertility cases was treated with in vitro fertilization. However, there’s no guarantee that the woman will become pregnant and most importantly, carry the child to term. While infertility treatments have helped many couples have children, success rates differ depending on the type of treatment.

Do Insurance Plans Cover Infertility Treatment?

The degree of services covered depends on where you live and the type of insurance plan you have. Fourteen states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. While state laws vary greatly in their scope of coverage, the average couple going through infertility treatments pays at least half of their expenses out of pocket. The costs for these procedures and medications vary widely. On the low end, fertility drugs such as hormone therapy (used to induce ovulation or sperm development) run from $200 – $300 a month. In vitro fertilization, on the other hand (in which the egg is fertilized outside the woman) costs $8,000 to $13,000 per treatment. For more information about state laws, refer to the State Infertility Insurance Laws page of the ASRM website.

ASRM believes the desire to have children and be parents is one of the most fundamental aspects of being human. People should not be denied insurance coverage for medically appropriate treatment to fulfill this goal.

What impact does infertility have on psychological well-being?

Infertility often creates one of the most distressing life crises a couple has faced. The long-term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Many couples experience anxiety, depression, and feelings of being out of control or isolated.